Comparison of observed biochemical recurrence-free survival in patients with low PSA values undergoing radical prostatectomy and predictions of preoperative nomogram.
Academic Article
Overview
abstract
OBJECTIVES: A preoperative nomogram is an effective tool for assessing the risk of disease progression after radical prostatectomy for localized prostate cancer. To better understand the performance of nomograms for patients with a low prostate-specific antigen (PSA) level, we examined whether patients with a PSA level <2.5 ng/mL had outcomes different than predicted by a validated preoperative nomogram. METHODS: A cohort of 6130 patients from 2 referral centers was analyzed. Kaplan-Meier methods were used to estimate the recurrence-free probabilities stratified by PSA group (<2.5 vs >or=2.5 ng/mL). Cox proportional hazards regression analysis was used to evaluate whether the PSA grouping was associated with biochemical recurrence, controlling for preoperative nomogram probability. RESULTS: Of 6130 patients, 399 (6.5%) had a PSA level <2.5 ng/mL. Patients with a PSA level of 2.5 ng/mL developed recurrence (total 607/6130). With adjustment for the preoperative nomogram probability, no significant difference was found in recurrence by PSA grouping (hazard ratio 0.78 for PSA <2.5 vs >or=2.5 ng/mL; 95% confidence interval 0.42-1.48; P = .5). CONCLUSIONS: Patients with a low PSA comprise a small proportion of those treated, and most have palpable disease. Patients with especially low PSA values (
